{% extends "myapp/base.html" %}

{% block main_body %}
   <!-- Content Header (Page header) -->
   <section class="content-header">
    <h1>
      电子病历管理
      <small>电子病历系统</small>
    </h1>
    <ol class="breadcrumb">
      <li class="active">电子病历管理</li>
    </ol>
  </section>

  <!-- Main content -->
  <section class="content container-fluid">

    <div class="row">
      <div class="col-xs-12">
        <div class="box">
          <div class="box-header">
              <h2 class="box-title"> <span class="glyphicon glyphicon-calendar" aria-hidden="true">添加电子病历</h2>
          </div>
          <!-- /.box-header -->
          <!-- form start -->
          <form class="form-horizontal" action="{% url 'myapp_Medrecordinfo_insert' %}" method="post">
            {% csrf_token %}
            <div class="box-body">
              <div class="form-group">
                <label class="col-sm-2 control-label">住院号：</label>

                <div class="col-sm-4">
                  <input type="text" name="hspid" class="form-control"  placeholder="住院号">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">主诉：</label>

                <div class="col-sm-4">
                  <input type="text" name="zhusu" class="form-control"  placeholder="主诉">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">现病史：</label>

                <div class="col-sm-4">
                  <input type="text" name="xianbingshi" class="form-control"  placeholder="现病史">
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">既往史：</label>

                <div class="col-sm-4">
                  <input type="text" name="jiwangshi" class="form-control"  placeholder="既往史">
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">婚育史：</label>

                <div class="col-sm-4">
                  <input type="text" name="hunyushi" class="form-control"  placeholder="婚育史">
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">月经史：</label>

                <div class="col-sm-4">
                  <input type="text" name="yuejingshi" class="form-control"  placeholder="月经史">
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">家族史：</label>

                <div class="col-sm-4">
                  <input type="text" name="jiazushi" class="form-control"  placeholder="家族史">
                </div>
              </div>

               <div class="form-group">
                <label  class="col-sm-2 control-label">体格检查：</label>

                <div class="col-sm-4">
                  <input type="text" name="tigejiancha" class="form-control"  placeholder="体格检查">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">专科检查：</label>

                <div class="col-sm-4">
                  <input type="text" name="zhuankejiancha" class="form-control"  placeholder="专科检查">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">辅助检查：</label>

                <div class="col-sm-4">
                  <input type="text" name="fuzhujiancha" class="form-control"  placeholder="辅助检查">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">鉴别诊断：</label>

                <div class="col-sm-4">
                  <input type="text" name="jianbiezhenduan" class="form-control"  placeholder="鉴别诊断">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">初步诊断：</label>

                <div class="col-sm-4">
                  <input type="text" name="chubuzhenduan" class="form-control"  placeholder="初步诊断">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">诊疗计划：</label>

                <div class="col-sm-4">
                  <input type="text" name="zhenliaojihua" class="form-control"  placeholder="诊疗计划">
                </div>
              </div>

              <div class="form-group">
                  <div class="col-sm-offset-2 col-sm-10">
                    <button type="submit"  class="btn btn-primary">保 存</button>
                  </div>
              </div>
            </div>
            <!-- /.box-footer -->
          </form>
        </div>
        <!-- /.box -->
      </div>
    </div>

  </section>
  <!-- /.content -->
{% endblock %}